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Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines

  • Valvular Heart Disease (TL Kiefer, Section Editor)
  • Published:
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Abstract

Purpose of Review

The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations.

Recent Findings

International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021).

Summary

The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15 years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.

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Authors and Affiliations

  1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Mia M. Pries-Heje & Henning Bundgaard

  2. Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA

    Mia M. Pries-Heje, Lindsey R. Baden & Ann E. Woolley

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Henning Bundgaard & Kasper K. Iversen

  4. Department of Cardiology and Department of Internal Medicine, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark

    Kasper K. Iversen

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MP and AW wrote the manuscript text and MP prepared tables. All authors reviewed the manuscript.

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Correspondence to Ann E. Woolley.

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Pries-Heje, M.M., Bundgaard, H., Iversen, K.K. et al. Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines. Curr Cardiol Rep 25, 1873–1881 (2023). https://doi.org/10.1007/s11886-023-02002-5

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